Aberdeen Grammar World Challenge visit to

Vietnam and Cambodia

The Grampian Travel Health Clinic

Ken and Peter Manson

Kemnay Pharmacy

Vietnam

Population: 90.7m Capital: Hanoi Location: South East

Asia Climate: Tropical in

south; monsoonal in north with hot, wet season (May-Sep) and warm, dry season (Oct-Apr)

Cambodia Population: 15.4m Capital: Phnom Penh Located: South East

Asia Climate: Tropical; wet

season (May-Oct); dry season (Dec-Apr); little seasonal temperature variation

Vaccinations

Vaccinations are given to protect you from conditions which you may be exposed to during your trip.

The advice we give is based upon the most up-to-date information available to healthcare professionals through the travel health specialist TRAVAX and is tailored to your specific itinerary

The following vaccines would be recommended for every member of the group:

Vaccinations Hepatitis A and Typhoid:

Disease prevalence is deemed to be "moderate to high" for these diseases which would make vaccination advisable. Cost: we can provide this vaccine free of charge via the NHS – this is a pioneering co-operative approach with the local surgery never previously facilitated with a pharmacy travel health clinic.

Rabies:

Thailand and Cambodia are both classified as "high risk" countries for rabies. A privately administered course of 3 vaccinations would therefore be strongly recommended.Cost: the vaccine is £50 per dose so a full course will cost £150 - your group discount will take this down to £135. This gives 10 years protection.

Hepatitis B:Optional vaccine - Carriage of the virus in the local population in this country is considered to be high (>8%) however transmission of this blood-borne virus occurs through blood contact and is considered where risk of physical injury is increased. A privately administered course of 3 vaccinations will give full protection (with option for single vaccine after one year to infer 10 year cover) Cost: £25 per vaccine meaning after discount price of £68

Vaccinations Japanese Encephalitis:

Vaccination would be advised due to risk during trekking. Spread by mosquitos (different mosquito to malaria) active during the day and particularly at twilight

Cost: £85 for each vaccine – course of 2 after discount £153

Diphtheria and Tetanus:Although vaccination is advised for these conditions, your national schedule vaccination programme will have inferred sufficient cover.

Rabies and animal bites

Infection of warm blooded animals including bats Transmitted to humans through saliva of infected

animal – usually through bite but not exclusively You cannot tell visually if an animal has rabies Avoid contact with animals including domestic pets Vaccination given as course of 3 injections

What to do if bitten by an animal

Copious flushing with running water for as long as possible (at least 10 minutes)

Do not scrub If alcohol or iodine are available apply after flushing Call medical assistance If vaccine course is given before trip then rabies

immunoglobulin (derived from blood products which are best avoided) is not required

2 further doses of vaccine are sometimes given

Blood-borne viruses

Blood-borne viruses are transmitted through contact with blood and body fluids. Main risks include:

Unprotected sexual intercourse Anything increasing the risk of a physical accident Any procedures where the skin is punctured eg

piercing, tattooing, acupuncture. Any procedure where skin may be cut such as hair

shaving Attending a “bloody” injury without protection such

as gloves Close contact sports

Malaria Risk

Malaria risk

Malaria is a serious and sometimes life-threatening illness. It is spread through the bite of a specific female mosquito

Both countries are classified as “high risk” for malaria Advised antimalarial tablets – two choices:

1. Doxycycline 1 daily for all of trip + 4 weeks £14

2. atovaquone/proguanil 1 daily for all of trip + 1 week £65 Mosquito nets – protect against mosquito and other biting

insects during the night. Impregnated nets advised. We can supply high quality individual nets.

Basic principles for preventing malaria

No antimalarial tablet is 100% effective A – Awareness of risk B – Bite avoidance: using DEET,

appropriate clothing and mosquito nets C – Use chemoprophylaxis correctly: taking

antimalarial tablets properly D – Report any symptoms to Doctor and

mention your travel if any flu like symptoms in next year

Insect repellent

DEET is the most effective and only recommended insect repellent for malarious regions

Has been used for over 50 years 50% DEET recommended for application

which will give up to 12 hours cover When applied with sun-screen: apply sun-

screen first then DEET on top

Sun protection The sun will be much stronger in South East Asia than in

Scotland Doxycycline increases sensitivity to sun – for anyone with a

previous history of photo sensitivity or who is of particularly fair complexion the alternative, but more expensive, regime of Atovaquone /Proguanil should be considered.

Long clothing provides good cover Using a high factor sun-screen on exposed skin – SPF30 and

over advised Reapply every two hours Use sun protective lip-salve Wear sunglasses that have UVA and UVB filters Apply sun-screen before insect repellent: this allows sun-screen

to be absorbed into skin

Heat precautions Takes time to acclimatize to hot climate If possible stay out of direct sunlight between 11am and 3pm Drink plenty of fluids Dark urine an indicator of dehydration Hand held fans can be useful when it’s not possible to escape

heat Heat exhaustions – symptoms: tiredness, dizziness, feeling faint,

headache. Treat by getting out if heat when possible and rehydrating with water: rehydration sachets can be useful. Heat exhaustion can lead to heatstroke which is more serious and requires medical attention.

Prickly heat – symptoms: rash caused by sweat glands becoming congested. Regular washing will help, apply Eurax cream or lotion for symptomatic control.

Water purification

Boiling water for 3 minutes will purify it While allowing boiled water to cool the

container should be covered to prevent recontamination

When this not possible chlorine dioxide purification drops or tablets are recommended – we can provided these from the pharmacy

Asthma and other conditions

Ensure that you will have enough medication for whole duration of trip

Carry a letter from the doctor or nurse outlining any conditions you have

Remember with asthma acute control may be needed more regularly in extreme heat and with activities like trekking

Making sensible food choices Avoid unpasteurised milk and milk products such as

cheese and ice cream Meat should be freshly prepared, thoroughly cooked

and eaten while hot whenever possible Leftover cold food should be avoided Vegetables should be eaten cooked when possible Fruit should be peeled because the skin can be

contaminated by insects Salads should be avoided due to easy

contamination Avoid fish and shellfish

Hygiene

More care and attention needs to be paid to hygiene

Wash hands prior to eating and after using the toilet

Having alcohol hand-gel and hand wipes can be useful

Use alcohol wipes to clean dishes cups and utensils if necessary

Travellers diarrhoea

Usually self limiting Important to prevent dehydration -

rehydration sachets can be useful in replacing salts and sugars

If continues for more than 3 or 4 days or if accompanied by vomiting medical advice should be sought

Recommended clothing

Covering up with loose clothing protects from both sun and biting insects including mosquitoes

Light materials like cotton and linen are best DEET 100% for spraying on clothes before

trekking

Health insurance

Speak with your group leader to ensure that everything is in place for the health insurance of the group

No reciprocal health care agreement with the UK

Pharmacy products We can prepare a group pack with all medical

requirements catered for both the expedition groups as well as providing an individual kit for each member of the group – we will apply a special group discount to all products supplied.

We have an extensive selection of specialist travel products including first aid kits, high quality mosquito nets, DEET sprays, sun protection etc

In addition we can apply group discount to other products including hand-gel and hand-wipes, analgesics, antihistamines, loperamide, rehydration sachets, Eurax, and any other products required.

Further information

http://www.kemnaypharmacy.co.uk/index.html

http://www.fitfortravel.nhs.uk/home.aspx